title: Safety of angiotensin-converting enzyme inhibitors while receiving venom immunotherapy.
abstract: BACKGROUND
  Case reports have raised concern about concurrent use of angiotensin-converting enzyme inhibitors (ACE-Is) in patients receiving venom immunotherapy (VIT). No surveys have been performed on the number of venom allergic patients who take ACE-Is and their outcomes.
  
  
  OBJECTIVE
  To survey the use of ACE-Is and systemic reaction (SR) characteristics in patients receiving VIT.
  
  
  METHODS
  A retrospective medical record review was performed on all patients evaluated for Hymenoptera venom allergy at a single center from 2000 to 2005. Patient records were evaluated for presenting symptoms, specific IgE testing, VIT treatment course, ACE-I use during VIT, and the presence of any SRs to field stings or VIT.
  
  
  RESULTS
  Of 288 patients evaluated from 2000 to 2005 for Hymenoptera venom allergy, 157 were found to have venom specific IgE. Of these 157 patients, 79 (50%) of those with Hymenoptera venom allergy underwent VIT. Seventeen of these 79 patients (21%) were taking an ACE-I during VIT. The mean overlap of a patient taking an ACE-I with the time they were receiving VIT was 30.9 months (range, 3-114 months). Patients taking ACE-Is were older (mean age, 56.2 vs 36.4 years; P < .001) and received VIT for a longer period (mean, 72.3 vs 29.9 months; P < .04). Thirteen of 62 patients not taking an ACE-I (21%) experienced an SR during their VIT. No patients taking an ACE-I experienced an SR to VIT while taking an ACE-I (P = .03).
  
  
  CONCLUSIONS
  This study suggests that there is not an association between ACE-I use and increased frequency of SRs to venom immunotherapy.
authors.affiliation: Allergy/Immunology Clinic, Wilford Hall Medical Center, Lackland AFB, San Antonio, Texas 78236, USA. kevin.white@lakenheath.af.mil
authors.forename: Kevin M
authors.initials: KM
authors.lastname: White
authors.forename: Ronald W
authors.initials: RW
authors.lastname: England
mesh_terms: D000328:Adult; D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D000818:Animals; D001180:Arthropod Venoms / Q000276:immunology*; D003888:Desensitization, Immunologic; D005260:Female; D006801:Humans; D006927:Hymenoptera / Q000276:immunology*; D006969:Hypersensitivity, Immediate / Q000276:immunology / Q000628:therapy*; D007073:Immunoglobulin E / Q000097:blood; D007299:Insect Bites and Stings / Q000276:immunology*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000806:Angiotensin-Converting Enzyme Inhibitors; D001180:Arthropod Venoms; D007073:Immunoglobulin E